Closure of Nottingham unit shows dismantling of NHS

Small charities vulnerable to collapse have stepped in to cover the gaps left by NHS cuts, photo by EMAS NHS Trust (CC) (Click to enlarge)

Chris Jackson, Nottingham Socialist Party

Nottinghamshire Healthcare Trust is planning to shut down a unit for people suffering from serious alcohol and drug addiction issues. The closure of the 15-bed Woodlands Unit at Highbury Hospital in Bulwell is the latest cut to mental health services in Nottinghamshire, and may force patients to be sent to local A&E departments.

It comes as a direct result of using 'competitive procurement' (the market) to determine the future of services. No local NHS provider is able to provide a safe and viable service at the market average rate of £239 per occupied bed day, and the trust is looking outside the NHS to find an organisation able to provide a service at this rate.

Vunerable users

In October 2013, a report by the Centre for Health and the Public Interest stated that "the experience of the introduction of social care markets in England over the last two decades is that competition has driven costs down, reduced the quality of services, led to the casualisation and deprofessionalisation of the workforce, and left care users and their families vulnerable to a major provider collapse."

While this report refers to the care sector, there is evidence that these findings are being replicated across the NHS with the increasing use of market competition. Users of the Woodlands Unit are now at risk of similar failings.

The future of the unit was discussed by the trust at a secret meeting in August 2017. Framework, a local housing charity, has been in discussions with the trust about taking over the service, undercutting NHS providers. If this goes ahead, the service will be threatened with similar issues which have undermined services in the care sector:

Casualisation of the workforce - Framework is offering worse pay and conditions than the NHS and only one person out of the 20 existing staff is planning to stay on and work under these conditions. While not exactly casualisation, the effect will be that the valuable skills and experience of NHS trained staff will be lost. This will inevitably lead to:

Reduction in service quality - Woodlands was a centre of excellence when it opened. But a report by the Care Quality Commission has revealed that almost three quarters (72%) of private providers inspected were failing in at least one of the fundamental standards of care.

Vulnerability to provider collapse - if Woodlands were simply being left to close, there would be a public outcry, and the possibility of a campaign similar to that which helped keep the Glenfield heart unit in Leicester open. There are no guarantees that Framework will be able to maintain the service long-term.

As well as demonstrating the hollowness of the government's aim to provide 'parity' for mental health and other services, the prospect of Framework coming in to take over the service shows the role charities are being forced to play in dismantling the NHS. Framework, a homelessness charity, itself struggling to survive at a time of cuts to local services, has diversified from providing hostel accommodation to providing mental health support services, advice and guidance, and support into employment.

Charitable organisations which were set up to meet a certain need are being forced to follow the money and shift to meet other needs to fill the space left when statutory services are no longer funded. The government's justification for introducing the market is to increase quality and improve patient choice, but in fact the whole strategy is a step towards privatisation, whose real aim is to provide profits.